10 - Gynae - Genital Tract Infection - Infections of Uterus and Pelvis - Acute Pelvic infection and PID Flashcards
PID or salpingitis - ST pelvic infection/?
incidence ?
?, poorer, sexually active ? women most at risk. Pelvic infection never occurs with a viable ?
endometritis incr younger nulliparous pregnancy
aetiology - ? infection of bacteria in ? and cervix.
sexual factors account for ?%
more common if dont used ??
? is partially protective, as is ? IUS
spread of prev ? STIs to pelvis is usually ? but can be from uterine ? (eg ?, ERPC, laparoscopy and ? test, and ?) and/or complx of ? and ?
descending infection from local organs eg ? can occur.
ascending vagina 80 barrier contraception COCP mirena aSx spontaneous instrumentation TOP dye IUD childbirth and miscarriage appendix
Pathology/bacteriology - what are the two no1 STI culprits?
? and bilateral ? and parametritis occur, ? rarely affected .
chlamydia and gonococcus
endometritis
salpingitis
ovaries
Hx points
- many have no Sx so presx later with ? or ? problems
- what is hallmark Sx? usually with abnormal pv bleed or ?
subfertility
menstrual
bilat lower abdo pain w deep dyspareunia
discharge
Ex points
- in severe Ex reveals ? and high ?, signs of lower abdo ? with ? adnexal tenderness and cervical ? (pain on moving the cervix)
Mass (pelvic ?) may be felt ?
more frequently the diagnosis is not clear and can be confused with ? and ovarian ? accidents (usually ? pain) or ?? (preg test ? with unilateral pain)
tachycardia fever peritonism bilateral excitation abscess vaginally
appendicitis cyst unilateral ectopic preg \+ve
Ix - ? swabs taken for ? and gonococcus, ?? sent if fever.
WBC and ? may be raised.
Pelvic ??? helps r/o ? or ovarian ?. Laparoscopy with ? biopsy and culture is gold standard
endocervical clap blood cultures CRP USS abscess cysts fimbrial
MGMT
- ? and either a parenteral cephalosporin eg ?? ? , followed by ? and ?
-? pts should be admitted for IV therapy
-review diagnosis after ? if no sing improv - then ? done
- pelvic abscess may not respond to ? therapy and may need ? under ??? or ?
Rupture of large ? ? can be life threatening
analgesia IM Ceftriaxone doxy and metronidazole febrile 24h laparoscopy ABx drainage USS / lap pelvic abscess
Complx
-main early complx is formation of abscess or ?
later many women dev ? obstruction and ?, chronic pelvic ? or chronic pelvic ?
?? if 6x more common after pelvic infection
chance of ? damage after one acute episode of PID is 12%
pyosalpinx tubal subfertility pain infection ectopic preg tubal
